CVS Examination Proforma

General examination
• Elderly Gentleman /lady
• Build,
conscious, oriented to time place and person
• Is he in respiratory distress- usage of accessory muscles of respiration –
please name them
• Lying comfortably in a propped up position
• Make a note of IV line, NG, CBD or any other drains/ Mobility Aids
(Elderly)

• Pulse - ##/min regular in rhythm, normal volume, character, Normal

arterial wall, all peripheral pulse equally felt, no radio-radio or radio-
femoral delay – Or you can say all peripheral pulses equal and bilaterally
synchronous.
• Pulse Deficit – In case of AF or Ectopics

• BP - ##/##mm Hg right arm in supine position

- ##/##mm Hg left arm in supine position
- ##/##mm Hg Right Leg
- ##/##mm Hg Left Leg

• JVP – Raised Y/N, if Y **cm, which wave - a, c v or x, y descend

• Hepatojugular reflex +/-

• Clubbing Y/N. if Y grading

• Peripheral cyanosis +/-
• Central cyanosis +/-
• Pallor +/-
• Icterus +/-
• Immature or mature cataract +/- or Pseudophakia (Elderly)
• Arcus senilis +/-. Pupil size
• Fundus – Roths Spot+/-, HTN/DM Retinopathy changes with grading
• Tongue appearance – Macro/micorglossia, Geographic, Fissured, Black
hairy tongue, Bald tongue, ulcers etc…

• Axillary, cervical lymph nodes, Supraclavicular, Epitrochlear & Inguinal

+/- →Size, Shape, Consistency, Matting+/-, Fixed+/-
(Mention about nodes when u Suspect TB/Sarcoidosis only – features of
constrictive pericarditis or restrictive cardiomyopathy)

• Oral Cavity – Hygiene +/-, Caries +/-, No of missing tooth (Elderly)

• Sacral Edema +/-
 • Pedal edema +/-, If Y Pitting/Non Pitting, extend

• Periperal Signs of Aortic Regurgitation such as ….

• Periperal Signs of Marfans (Young)

• Periperal Signs Infective endocarditis/Rheumatic fever(Youngs)

• Peripheral signs of insulin resistance such as xanthelesma, xanthoma ,

acanthus nigericans or skin tags

• Periperal Signs of Genetic Disorder/Syndromes/Dysmorphic feature

(Young)

CVS system Examination

Inspection
• Precordium – Normal/bulge
• Apex Beat – Visible or not/Double or Single/Space
• Other Visible Pulsation - Aortic A2/Pulmonary
P2/carotid/Suprsternal/suprclavicular/epigastric/Suzmans sign/Hepatic

• Shape of chest wall – Elliptical/pectus excavatum/carnatum/barrel

shaped
• Kyphosis +/-
• Scoliosis +/-
• Skin overlying the chest wall
o Dilated Veins chest wall or flanks +/-
o Scars – Mid or Lat thoracotomy scars +/-
Infraclavicular Scar +/-
o Sinuses +/-

Palpation
• Apex beat - LV/RV Apex
o Space - left 5th/6th ICS ## cm lateral or medial to Mid clavicular
line/ ##cm anterior to anterior axillary line
o Single or Double Apex
o Type of Apex – Normal/Hyperdynamic/Irregular/tapping or
Heaving
(Always look for scoliosis before commenting on Apex beat)
• Parasternal Heave +/-, if +e grading
• Palpable (Shocks) P2 or A2/Click/Opening snap/thrills

Percussion
▪ Right Border corresponds sternum
▪ Left Border correspond with apex beat
▪ No Evidence Pericardial effusion/Dextrocardia/DCMY
▪ Dullness in Aortic space +/-
▪ Dullness in Pulmonary Space +/-
Auscultation

• S1 - Mitral or Tricuspid
Loud/Soft/Variable/Splitting/Reverse Splitting

• S2 – Absent/Soft/Loud A2 or P2/Single S2/Splitting/Wide fixed

Split/Reverse split

• S3 – LVS3 or RVS3

• S4 – Present/Absent
• Gallops +/-
• Opening Snap +/-
• Clicks +/-
• Pericardial Rub +/-, Pericardial Knock +/-, Prosthetic sound +/-

• Murmors

• Mitral – MDM/PDM/Austin Flint /Functional PSM

(To describe the character of murmur, Grading, Radiation, intensity
with respiration, Dynamic auscultation findings)

• Tricuspid – MDM/PSM/Function MDM or PSM

(To describe the character of murmur, Grading, Radiation, intensity
with respiration, Dynamic auscultation findings)

• Aortic – ESM (Gallavardin Phenomena)/EDM/Function Murmor

(Elderly)
(To describe the character of murmur, Grading, Radiation, intensity
with respiration, Dynamic auscultation findings)

• Erbs Area or 2nd Aortic – EDM with description of murmur

(To describe the character of murmur, Grading, Radiation, intensity
with respiration, Dynamic auscultation findings)

• Pulmonary – ESM/Graham Steel Murmor/ Functional Murmor

(To describe the character of murmur, Grading, Radiation, intensity
with respiration, Dynamic auscultation findings)

• Gibsons Area – Continous Murmor

• Early Systolic murmur/ Late systolic murmur/ late Diastolic Murmor

to be mentioned only if it is very evident

• Carotid bruie +/- , Subclavian Bruie +/-

DIAGNOSIS – congenital or acquired or degenerative valvular heart disease
mention predominant valve disorder, followed by other
valves in the order of severity

or

congenital heart disease cyanotic or acyanotic

ETIOLOGY – RHEUMATIC/I.E/INFLAMMAORY/CONGENITAL
PAH – Y/N
SINUS RHYTHM OR AF OR ECTOPICS
IN CARDIAC FAILURE OR NOT
NO EVIDENCE OF I.E